Republic of the Philippines

AURORA STATE COLLEGE OF TECHNOLOGY

Baler, Aurora
REGISTRATION FORM
CTRL No.: ___________
Name Ordinario, Clarin, P Student No. 19-01-0673 Sem: 2nd SY: 2021-2022

3r
Course: BSED Year: Section: Science ☐ New  Old ☐ Transferee ☐ Cross Enrollee ☐ Foreigner
d
Class Code Course No. Subject Description Units Professor Schedule
G152 PHYS5 Modern Physics 3.0 R.Gongob 8-11 am M TBA
G159 SCI 4 Research in Teaching Science 2 3.0 K.Valete 2-5 pm M TBA
EDUC 10
G155 Building and Enhancing New Literacies Across 3.0 R.Talavera 8-11 am T TBA
NEW
G154 BIO 3 Microbiology and Parasitology 4.0 K.Valete 11-5 pm T TBA
G160 EENVI 3 Earth Science 3.0 R.Gongob 8-11 am W TBA
G157 EENVI 4 Environmental Science 3.0 R.Gongob 1-4 pm W TBA
G153 BIO 4 Anatomy and Physiology 4.0 K.Valete 8 am-2 pm Th TBA
G156 SCI 3 Technolog for Teaching and Learning 2 3.0 N. Del Mundo 2-5 pm Th TBA
G158 CA 2 Course Audit 2 3.0 K.Valete 8-11 am F TBA
N/A N/A N/A N/A N/A N/A

Total Units: 29 Approved by: _____________________ ________________

Department Director Date
STUDENT’S PLEDGE
In consideration of my admission to the AURORA STATE COLLEGE OF TECHNOLOGY and of the privileges of a
student in this institution, I hereby promise and pledge to abide by and comply with all the rules and regulations laid down by
competent authority in the College or school in which I am enrolled.
PERSONAL DATA
Femal Civil
Sex: Single Age: 21 Tel/CPNo. 09519988705
e Status:
Home Address: Brgy. Ditumabo, San Luis, Aurora Nationality Filipino
Birth Place: Ditumabo, San Luis, Aurora Birthdate October,26,2000
Claireperez696@gmail.co
E-mail Address
m
Religion: Iglesia ng Dios Living with Family? Yes OTHER IMPORTANT INFORMATION:
Dialect: tagalog Are you boarding? No Kindly check the box applicable to you

Father’s Name Nomelito B. Ordinario Occupation: farmer ☐ PW

Mother’s Name Susana P. Ordinario Occupation: Housewife ☐ Indigenous People (IP)
Click or tap here to enter
Person Supporting you (if other than parents) Pls. Specify:
text.
Click or tap here to enter Click or tap here to
Name: Occupation:
text. enter text.
Address: Click or tap here to enter text.
Person to Contact in case of emergency
Name: Susana P. Ordinario Occupation: housewife
Address: Brgy. Ditumabo, san luis aurora
EDUCATIONAL BACKGROUND
Elementary Ditumabo Elementary school Year Graduated: 2013
Secondary Ditumabo National High School Year Graduated: 2019
Collegiate Aurora State College of Technology Year Graduated: N/A

1/22/2022
__________________ _________________
Signature Date

ASCOT-OCP-OVPAA-ANT-RO-F01
Rev 00 (06.01.2020)
 STUDENT DATA PRIVACY CONSENT FORM
I, CLARIN P.ORDINARIO, am fully aware that the Aurora State College of Technology (ASCOT) or its
designated representative is duty-bound and obligated under the Data Privacy Act of 2012 to protect all my personal
and sensitive information that it collects, processes, and retains upon my enrolment and during my stay in the College.
Student personal information includes any information about my identity, academics, medical conditions, or
any documents containing my identity. This includes but not limited to my name, address, names of my parents or
guardians, date of birth, grades, attendance, disciplinary records, and other information necessary for basic
administration and instruction.
I understand that my personal information cannot be disclosed without my consent. I understand that the
information that was collected and processed related to my enrolment is to be used by ASCOT to pursue its legitimate
interests as an educational institution. Likewise, I am fully aware that ASCOT may share such information to
affiliated or partner organizations as part of its contractual obligations, or with government agencies pursuant to law or
legal processes. In this regard, I hereby allow ASCOT to collect, process, use and share my personal data in the
pursuit of its legitimate interests as an educational institution.
In addition, I am likewise giving my consent/permission in favor of my parents/guardian/representative or
whoever is responsible for providing care for me to access, verify, examine, and or inspect my academic and
scholastic records, school fees/accounts in the College, the result of my physical medical examination (PME) and all
matters that relate to my status as a student of the College.
Finally, should I commit any misconduct or should there be a complaint filed against me, before the Office of
the Student Affairs and Services by reason of a violation of the provisions of the Student Handbook or any Laws or
ordinances, I hereby authorize and give my full consent in favor of the College of informing my parents, guardian,
representative, or whoever person is in charge of providing care or custody for me.
Upon signing this document, I hereby give my consent for the processing, release, and retention of personal
information.

1/22/2022
__________________ _________________
Signature Date